Emily's First Day of Pre-School

Today was Emily's first day of school! She was so cute as she walked out of the house this morning on her way to the car. She had her new Princess backpack & was pulling it with such pride. We asked her to stand in front of the house (of course the sun was right in her eyes) for a couple pictures for her first day of school. As usual she is a cheese!

When we got to school she grabbed her backpack & decided she wanted to wear it on her back! She was so cute & her backpack is just about as big as she is! I am surprised she didn't fall over backwards. As we walked through the school gates we meet with one of the classroom assistants She showed us around Emily's classroom & told us a little about their daily schedule. The boys thought it was really cool to see where Emily was going to school. We found out that Mondays she will have music therapy & speech therapy. The classroom assistant showed Emily where to place her backpack. Then she took her outside to meet some of her classmates. There are 3 new students (total) beginning today in Emily's class. She was a little shy at first but the assistant asked if she wanted to play in the sandbox & off they went! It was great! No crying, clinging or hiding! She went & played in the sandbox with some of the other kids & we were able to watch her interact. She did great. We made our escape & went to lunch (before Matt had to be back to work).

I went to pick her up after school by myself (well the other 3 in tow). She was happy to see us, grabbed her backpack & out the door. The teacher Ms. Abbott said she did wonderful! She cried just for a moment during music time (which I think might have to do with her hearing because she always does that when a group sings). Other then that she did great!! We will see how tomorrow goes!

We still don't have transportation set up! Seriously I cant believe how slow the District Office is. I have called 3 days & left messages. I am not sure how it is going to work since the boys go back to school tomorrow! I am either going to have to get the boys 10 minutes early or be 10 minutes late to get Emily. Thus the reason for transportation. I think tomorrow I will have to get a little aggressive & try to talk to a management type person. If I do I bet I will have services on Thursday.

~The Big Day~

Tomorrow is the big day! My baby girl starts pre-school. We talked to her a little today about it. I don't think that she really understands that what school is. I am excited, Matt will be taking a long lunch & meeting us at school so he can be there for her first day. It is still so hard for me to believe. She is so tiny still & just doesn't seem old enough. But its going to be great for her to start learning & making progress! I am also excited to have a little one on one time with Cameron (which I was able to have with Emily at this age). We will update everyone tomorrow after school!

Pre-School

Emily starts school in 5 day!! Wow, I realize that I am not ready. She is my baby girl & I am not sure how I will make it through the day without her. I know its only 3 hours 4 days a week. But when you are used to having your kids with you all the time its like a piece of you is missing when they go to school. I know that its a great opportunity for her & that she will learn so much. I know that she needs it really bad etc... But right now I really want to be selfish & not want her to go!! I think after spending the last 3 years (pretty much constantly) with her I deserve to have this moment! Okay, I feel a better now. Am I allowed to miss her now even though she hasn't started? Oh man, where does the time go?

We got her (okay Daddy folded...hehehe) a Disney Princess backpack with wheels! It didn't come real cheap but that's due more to the wheels the the Disney Princess theme. She has to have a backpack to fit her take home folder & notebook. So that means a regular sized backpack which on Emily, well pretty much is the same size as her. It was so funny in the backpack aisle at Target. She almost fell over (nothing in it) so Daddy decided to get the wheels. Good choice Daddy! She loves it!! 

Did I also mention that Emily will have to ride the bus to school! This is the hardest thing for me. I think because I am so particular (thats the nice way of saying it) about car seats. She will be in a car seat on the bus & yes it does have seat belts. Its just that I wont be there! I wont let Matt install the car seats in our car because if they aren't right a child could get seriously hurt in a fender bender! The only reason why we are getting it is because of a scheduling conflict between Emily's pre-school & the boy's school. The boys are out at 2:40 & Emily is out at 2:55. I don't physically have enough time to get from the one school to the other. Not unless I get a turbo boost on the minivan! JK! Next year (if the boys are still at Eduprize) I am going to try & get Emily in morning pre-school (then I don't think there is a time conflict). If we Home school there wont be a problem at all with me driving her there. 

One last crazy rant... who in their right mind decides to do "projects" (such as cleaning out closets, entertainment centers, cupboards, spring cleaning things...) while all of their kids are at home board on Spring Break? Some on who is CRAZY that's who. I do really think that my mind is lost. So this is your notice that if you find it please return it! I have come to my senses & I am just trying to survive the last few days of spring break & I can do clean up when the kids are back in school! But mean while my house looks like a cross between tornado Emily & WWIII (Alex & Hunter). Plus my dish washer is gone (he's in Colorado). I am so used to our deal that the cook doesn't clean that I am not sure I remember what the dishwasher looks like. Okay, now I am done. 

Have a Fantastic Day!

Hearing

Emily had her hearing tested again yesterday with our AzIEP Coordinator. Its been about 9 months & on her first test with them she passed one ear & we couldn't get a reading on the other ear. This time she got referrals on both ears. Which essentially means she failed the pre-screening test. There are many reasons why she failed them. Either she is about to get or recently had a ear infection (that would be the easiest & least life altering). My guess is due to the amount of ear infections she has had & her speech issues she probably has fluid in her ears. That would more then likely mean she would need tubes put in. The other reason could be some level of hearing loss in one or both ears. This wouldn't completely shock me (I have a immediate family member who is sever-profoundly deaf). We will be taking Emily to a ENT (ears, nose & throat) doctor as soon as Matt's insurance kicks in (so the end of April). We are going to request that they do a ABR test. This test is done while the child is asleep (or sedated for toddlers & older children). It is the best & most accurate test. Plus we do not feel that Emily will do well with the regular hearing tests due to her Apraxia.

I always knew that ears are complicated, I just never really looked at one so closely! I am amazed that there aren't more people out there that have hearing issues. I recently had a ear infection that lasted just over a month. During that infection I lost partial hearing in my left ear. Boy was it horrible. Going from being able to hear to asking for everyone to repeat themselves over & over again. It is amazing how one little thing works. Wow, are ears amazing.

Auditory brainstem response (ABR) test

An infant is sleeping or sedated for the ABR. An infant may be sleeping naturally or may have to be sedated for this test. Additionally, older, cooperative kids may be tested in a silent environment while they're visually occupied. Tiny earphones are placed in the ear canals. Usually, click-type sounds are introduced through the earphones, and electrodes measure the hearing nerve's response to the sounds. A computer averages these responses and displays waveforms. Because there are characteristic waveforms for normal hearing in portions of the speech range, a normal ABR can predict fairly well that a baby's hearing is normal in that part of the range. An abnormal ABR may be due to hearing loss, but it may also be due to some medical problems or measurement difficulties.

-http://kidshealth.org

Oral-Motor Exercises Today!

Here are all of the oral-motor exercises we did today. They are fun & exciting for my Miss Pretty! We are supposed to spend 10-20 minutes 2-3 times a day. Today we had 2 sessions. The first was just Emily & Mommy. We spent probably 15 minutes making faces & playing our new whistles & silly noise makers. She carried the slide whistle around for half the morning blowing on it! Our 2nd session was this afternoon. Alex & Hunter joined us as well. The pictures below are from our afternoon session. We probably spent a good 40 minutes "playing" at the table. We all had so much fun.

Lizard

Emily loves to watch Signing Time while eating breakfast. She asks every day! I think we are watching "Leah's Farm". It has a ton of animal signs & a silly song about turtle rock. I have found that music is another way that Emily is able to connect with speech! When it is a song on a movie or TV show she really pays attention. She tries to say some of the words in the song. If she is unable to say any of the words she at least picks up on the sound & tone fluctuations.

Peanut Butter Therapy

We have been working hard everyday (usually 2 or 3 times a day) on our oral-motor exercises. This is definitely one of our favorites! Spread peanut butter all over your lips & can only get it off by licking your lips with your tongue. No cheating by using your hands or teeth (or even rubbing your lips together)! The boys also had a blast doing this with her. She is also holding a silly straw (crazy shapes). We use those to blow tissue across the table at each other. The more bends & twists the straw has the hard you have to blow. Emily doesn't like this exercise as much but will do it when the boys join us.

Apple Sauce Sucking

Yum! We love to drink anything thick through a straw. Oral-motor exercises are a kids dream come true. They get to play with their food essentially! Drinking apple sauces, milk shakes, yogurt & pudding through straws. We get to pick up Cheerios's off the table with our tongues. We get to eat hard chewy candy & gum. I am hoping never to hear a complaint about oral-motor therapy ever!

Silly Faces

At 3 making silly faces is what life is all about! We get to do for therapy!! Silly faces is probably our favorite oral-motor exercise so far. Why... because we can do it anywhere we go. Everyone is laughing & having fun. Who doesn't love to stick out your tongue & try to touch your nose or chin?! Who doesn't like to wiggle your tongue from side to side & top to bottom?! I tell you, if Emily knows anything it is how to be super silly!

Things at Home 

We have officially started our at home oral-motor therapy. Amber (Emily's ST) gave us a great list of OM ST to work on with Emily. So far its been fun. We have been pick the really fun things to do like drinking milk shakes out of straw & eating hardened chewy candy. She has no idea that we are working on strengthening her little tongue, lips & jaw. 

We are also working on other communications things... I am continuously increasing signing & we are going to start working on PECs (picture communication exchange communication systems).  Its a system of pictures that Emily can choose & point to want she needs or wants. Since Apraxia is a motor planning disorder she has a hard time coming up with signs spontaneously (just like words). She will run through her list of signs (in a specific order) trying to figure out which one she wants to use. With the PECs she doesn't need to spontaneously come up with anything. She looks at the pictures & points to the one that represents what she is trying to say. We will then reinforce the sign & the verbal word. 

I have also been working on the alphabet in sign & verbal. I  find that Emily responds well to music. She may not be able to say the words but she is able to fluctuate her voice to match the pitch & rhythm of the song. We are working on writing... such as drawing straight lines & circles. We are trying to work on patterns but mostly with that we are working on repetition (for speech). 

She is a amazing little girl! Everyday I learn something new from her.  

Patience & Understanding!

Emily is very eager to learn anything & everything. Her comprehension is at or above age level. She does act younger but only because it is so difficult to live without communication!

Just for a moment try to imagine being able to comprehend everything someone is saying or asking. Now imaging you are unable to talk. How would you communicate what you need or want to that person? You would probably write it down, draw pictures or point. These are all things that you have learned as you grow. Well Emily hasn't learned how to write or draw yet. She is in the very, very early stages of learning to point (and/or sign). So now put yourself in her shoes. How would you communicate without writing or drawing. Its very hard to do. That is just a example of one of the problems Emily deals with due to Apraxia on a day to day basis.

I am learning to be more patient & understanding!

IEP Meeting! 

After a long 2 hour meeting I signed the paperwork. I didn't want to but signed it anyways. Matt asked me to. 

Emily's goals are to consistently use verbal, signing or PEC's (picture boards) communication 75% of the time during circle time, snack time & table time. She will be receiving at least 90 minutes of ST a month. Which will be in the classroom so that the Speech Therapist is able to work with her on the things she is doing in class. It essentially breaks down to approximately 23 minutes a week. So once we combine that with in home speech therapy, she will be getting at least 1 1/2 hours a week. Which at this age I am okay with. 

Emily gets a little overwhelmed when our therapy sessions are long. We have decided to break them into 30 minute sessions (at home). We are also partnering with our home Speech Therapist to create a "at home therapy" program that Matt & I will be doing with her 2-3x a day. Most of it will consist of Oral-Motor Therapy. There is information on Oral-Motor Speech Therapy below. We are also continuing to learn & teach signs everyday (we love signing time)! We are going to begin to use PEC's at home just until we either learn the sign for it or learn how to verbally say it (mostly so she knows how to use it when she goes to school). Unfortunately we will be losing at home speech therapy for about a month & a half. This is due to Matt's new insurance not beginning until the end of April. We do currently have insurance but it isn't very good, especially for this sort of stuff. Once we have our new insurance we have to pay for the deductable first! Yikes! 

What is Oral-Motor Speech Therapy?

Therapy designed for patients with muscle-based speech disorders related to poor muscle strength and difficulty with motor planning/coordination for speech movements. This approach uses therapy tools to systematically improve oral muscle movements.


Why use Oral-Motor Speech Therapy?

Normal muscle movement must exist for standard speech clarity to develop. Patients with muscle-based disorders do not have the muscle strength or endurance to support the development of intelligible speech (Rosenfeld-Johnson).

Many individuals who may benefit from an Oral-Motor Program are able to speak in short phrases or even in complete sentences, but they are very difficult to understand. If the muscle weakness is not addressed, these patients will continue to exhibit speech problems, specifically in connected speech (Rosenfeld-Johnson).


How Does Oral-Motor Speech Therapy Work?

Oral-Motor Speech Therapy uses a muscle-strengthening program in conjunction with traditional speech remediation techniques to:

. increase oral awareness
. develop correct placement for sound production
. increase strength within the oral musculature
. improve motor planning for speech movements
. improve speech clarity


Who Can Benefit?

Patients who experience excessive drooling, tongue thrust (tongue sticks out when talking), open mouth posture, weak breath support, speech that is difficult to understand, weak oral muscles (lips, tongue, jaw), lisping, poor oral awareness, or feeding problems can potentially benefit from an Oral Motor Program.

It has been a crazy weekend but not much new going on here.

This week is the big one! Emily has her IEP meeting on Wednesday. This will determine how much therapy (and what kind) she will be receiving in preschool! I have been doing tons of research & I am hoping to get Matt up to speed on all of it before the meeting (Wednesday) so we can go in on the same page. Even though our Speech Therapy has been cut (thru Early Intervention) I asked our ST to attend the IEP meeting with us to give her thoughts on what Emily's needs are. I hope that she will be able to help us get as much speech therapy as we can. She has also written up Emily's Assessment which I plan to bring with us.

Please pray that we are ale to get the services that Emily needs.

SPEECH AND LANGUAGE ASSESSMENT


Name:
Emily 
Date of Assessment:
2/27/09
Date of Birth:
4/12/06
Date of Report:
3/2/09
Age:
2 years 11 months
Diagnosis:
Expressive Language Disorder, Apraxia of Speech
Adjusted Age:
N/A



Reason for referral:
Emily has difficulties communicating with others effectively due to severe expressive language delay and articulation errors. After working with Emily since October 2008, evidence has indicated that apraxia may be hindering Emily’s progress in her intelligibility. The purpose of this assessment was to determine Emily’s current oral motor skills, and make recommendations as deemed necessary.

Sources of information:
File review, parent interview, therapist data, apraxia checklist.

Findings:
The apraxia checklist requires Emily to participate in a variety of motor tasks.

Gross Motor Coordination:
In this task, Emily was asked to clap while simultaneously counting to ten, marching, sitting then standing, running in place and jumping jacks. Even with maximum prompts, encouragement and models, Emily was unable or refused all tasks. She obtained a score of 0%.

Oral-Motor Coordination:
A variety of lip movements such as pucker/retracting lips, slow and fast kisses, hiding the top and then the bottom lip, slow/fast lip pops, and pressing the lips together were modeled for Emily. Although she did attempt these tasks, Emily was unable to perform any of these. Her pucker is open and her pressing of lips is weak an slightly open as well. Tongue movements such as sticking the tongue in and out 5 times, licking the top and then the bottom lip, slow and fast clicks, moving the tongue from corner to corner, and circling the lips clockwise and then counterclockwise with her tongue were all modeled for her. Of these tasks, Emily was only able to move her tongue from corner to corner. When circling her lips with her tongue, she is able to move her tongue along the bottom lip, however is unable to elevate her tongue and circle. When asked to touch her chin with her tongue, Emily is successful, however is unable to raise her tongue in attempts to touch her nose. Emily obtained a score of 10% on her oral-motor coordination tasks.

Sounds in Isolation:
In this task, Emily is asked to repeat each of the letters as well as the /sh/, /ch/ and /th/ sounds. Emily was only able to imitate the /sh/ sound successfully, obtaining a 3%.

C-V-C Words:
C-V-C words are given as verbal models and asked to be repeated. Emily did make attempts, however was unsuccessful in correct production. The results are as follows:
Bib - /buh/ Roar – (roared like a lion)
Pop - /puh/ Hot - /ah/
Mom - /bom/ Shush - /sh/
Wow - /buh/ Zoos - /zu/
Tight - /n/ Sis - /di/
Dad - /da/ Move - /mu/
Kick - /I/ Van - /va/
Gag – No response Fife - /mai/

Emily obtained a score of 0% on her C-V-C Words.

Multisyllabic Words:
Emily was instructed to repeat the following words: Hot dog, dinosaur, watermelon, hippopotamus, kindergarten teacher. Emily did attempt hot dog with /ah duh/, however was unable to imitate any of the other words. Her score on this task was 0%.

Repeating of sentences, expressions and words of increasing length were not attempted due to Emily’s lack of success at the other tasks.

Results of this assessment support a diagnosis of apraxia.

Summary and Recommendations:
It is felt at this time that Emily has shown minimal progress with her production of initial sounds, and she is not yet putting these sounds into whole words. Her speech production is inconsistent and her words are often times produced differently each time she says them. Emily is often seen groping in attempt to find the appropriate lip and tongue placement for sound production, even when in isolation. She will use signs with prompts, although tends to prefer to use word approximations as her mode of communication. She refuses to participate in oral-motor activities other than blowing bubbles; however her mother has been given some snack ideas with oral-motor activities attached. Emily’s success in blowing bubbles is inconsistent with her lip rounding and breath support.

Emily is a child that likes very much to be in control of her situation, and when a situation is presented in which a task is difficult for her, she will run from the room and use other avoidance tactics in order to regain control. She is a very bright girl and is able to follow directions, size concepts, spatial concepts (i.e. behind, in front of, next to, etc), and a variety of objects. Her receptive language skills are her strength at this time. Emily needs maximum prompting to increase her expressive language skills, thus becoming a better communicator. In addition, she requires extensive oral-motor therapy to increase her sound production and motor planning success. The focus of therapy for a child with apraxia, like Emily, should be on improving the planning, sequencing, and coordination of muscle movements for speech. In addition, it would be beneficial to have an occupational and physical therapist conduct a screening of Emily’s fine and gross motor skills.
Practice and repetition is key to Emily’s success. Often times, getting feedback from a number of senses, such as tactile "touch" cues and visual cues (e.g., watching herself in the mirror) as well as auditory feedback, is often helpful. With this multi-sensory approach, she will be better able to repeat syllables, words, sentences and longer utterances to improve muscle coordination and sequencing needed for speech.

Signing Time!

Emily signing "Signing Time"

Research shows that signing with children lessens frustration, opens the communication channels earlier, increases IQ's levels & can help them to talk earlier (for children under one). 

Signing Time are DVD's created to teach ASL to all children. They used to be a PBS show but no longer are due to costs of production. We checked out 8 Signing Time videos (4 don't work) a week ago from the library. Emily has probably added at least 10-15 new signs to her vocabulary in just the last week! She now asks (by signing Signing Time) to watch them over & over again! 

Believe it or not Emily is not the only one who loves to watch them... Alex & Hunter do as well!! They sing, they dance & they sign as well! The best part is they are learning to communicate with Emily. She thinks it funny when the boys use sign to talk to her... its very cute!

We love the Signing Time DVD's. They are the best tool for teaching children sign that I have found so far. I am so happy to have discovered them.

Our library's collection of Signing Time is limited. They have about 10 videos total. Signing Time has 2 different series with 13 DVD's in each series plus a baby series that has I think 4 DVD's in it. I think we are going to start our own collection at home since I plan on using it with Cameron as well & Emily. 

Check them out at... http://www.signingtime.com/

Emily signing "Horse"